enriching foods, enriching lives
Transcript of enriching foods, enriching lives
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FOOD FORTIFICATION IN INDIA:
ENRICHING FOODS, ENRICHING LIVES
Presentation by:
Deepti Gulati, Senior Associate,
GAIN: Global Alliance for Improved Nutrition
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Sixty-seven Years Ago ……..
When India became independent, we
faced two major problems, with grave
nutritional impact:
threat of famine and low agricultural
production and
lack of an appropriate food distribution
system
These were compounded by:
low dietary intake because of poverty
and low purchasing power;
high prevalence of infections due to poor
access to safe water, sanitation & health
care;
poor utilization of available facilities due
to low literacy and lack of awareness
RESULT: Population suffered from CED
and micronutrient malnutrition
Our Constitutional
Obligation:
Access to good nutrition and
health is a fundamental
human right and a
cornerstone that defines
health of all
Article 47 of our Constitution
reflects our commitment. It
states:
“The State shall regard the
raising of the level of
nutrition and the standard of
living of its people and the
improvement of public
health as among its primary
duties …….”
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Despite substantial strides in food
grain production,
Malnutrition amongst children in
India is highest in the world
India has 35 % of the world’s
malnourished children
Nearly a third of the world’s
hungry reside in India
About 26% 0f India’s population
- 268 million – are considered
food-insecure, consuming less
than 80% of minimum energy
requirements
Lets See How Are We Faring Today……
India is severely affected
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Why Focus on Hunger and Malnutrition ?
Hunger and malnutrition stunt growth -
intellectually and physically, leading to:
premature death,
disability, life-long susceptibility to
illness,
poor cognitive and learning skills,
low achievement in school,
low productivity and low wages, and
hence
poverty
Malnutrition starts early... Right from the
Womb
Malnutrition Affects:
Health and Survival
Educability
Economic Productivity
Disability
These are Irreversible
BUT Preventable !
Micronutrient Malnutrition
Impacts:
Learning ability
School performance and
Retention rates
Speech & hearing defects
These are Permanent !
Stagnating child and maternal malnutrition
rates, including micronutrient malnutrition
are at very high levels and their impact is
devastating…. This is unacceptable !!
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Nutrition and Health Indicators
Nutrition and Health Indicators India Madhya
Pradesh
Rajasthan
IMR 53 70 63
MMR 254 335 388
< 5 mortality 74 94 86
Underweight (<3 yrs) in % 40 58 40
Stunted (<3 yrs) in % 45 47 23
Wasted (<3 yrs) in % 23 40 37
Children anaemic (6-35 months) in % 79 83 79
Ever-married women anaemic (15-49 yrs) % 56 58 54
Ever-married men anaemic (15-49 yrs) % 24 25 22
Children age 12-35 months who received
atleast 1 dose of vitamin A (%) CES -2009
64 45 60
Mothers who consumed IFA for 90 days or
more when they were pregnant with
their last child (%): NFHS – 3
22 12 13
India’s 1/3rd population being children and youth, is considered as its
Demographic Dividend …. But with such high levels of micronutrient
malnutrition that seriously impair the development of human capital, labour
productivity and future social and economic development …..
This cannot be counted as our Demographic Dividend
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Micronutrient Malnutrition: 3 Options to Control
Supplementation
Two high-doses of Vit A per
year
Iron syrup and capsules
A safe and efficient strategy
for eliminating VAD &
Anaemia for improving child
survival.
Dietary Diversification
Food prices spiralling and
hence mostly cereals and
tubers. Low in vegetables,
fruits and lentils
Non-anima sources comprise
> 80% of intake.
Implementation and Scaling
up difficult,
Food Fortification
High consumption of Staples
Great hope for long-term
control of MND.
Potential to reach all income
groups through basic food
items with minimal changes
in eating habits.
Of these options, fortification is most efficient on account of comparatively lower
cost to implement & ability to yield significant results in a short period of time.
Affordability of a diversified
diet is a big question
GOI programmes reach only
about 55% of the children.
Compliance is also an issue
Only about 2% foods
available in the market are
estimated to be fortified
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Food Fortification: Benefits Outweigh Cost
Food Fortification / Enrichment: Addition of one or more essential nutrientsto food, for the purpose of preventing or correcting a demonstrateddeficiency of one or more nutrients at the population level / specific groups
Probably no other technology available today offers as large an
opportunity to improve lives & accelerate development at such low cost
& in such a short time* * (Source: Enriching Lives, The World Bank)
US $5 billion
in savings from
avoided deaths,
improved earnings
and reduced
healthcare spending
Copenhagen
Consensus
US $347 million
investment in
vitamins and
minerals
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Why Fortify Staples in Rajasthan and Madhya
Pradesh
Food India Rajasthan MP
Wheat 160g 250g 215g
Edible oil 14g 20g 20g
Milk 82ml 200g 180g
Consumption Patterns of Food (day/capita)*
Consumption of wheat, oil and milk in Rajasthan and
MP is higher than the national average
Diets are primarily cereal based and wheat comprises
70-90% of the total cereal consumption
Hence, these are good vehicles for fortification as
micronutrients can reach all population groups when
these fortified foods are consumed
* Source: Household Consumer NSS Report 2011 on Expenditure in India, 2009-10, 66th Round
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How We Started
Brought together stakeholders including the Industry partners through
informal and formal discussions
Discussed nutrition and health issues and highlighted their role in
malnutrition reduction
Many food processors got encouraged and wanted to start fortification
Undertook Industry assessment to understand the need for capacity
enhancement: infrastructure, manpower, QAQC
Managed fears / apprehensions / eliminated myths of Industry and
consumers through active scientific, social and media engagements
Strengthened systems for external regulatory monitoring
Got the Chief / Senior Ministers of the States to launch fortified foods
Organized many Media Workshops and Community Events to create
awareness and demand through print, electronic and social media
Launched a high-pitched social marketing campaign and promoted logos
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Large-scale food fortification projects in
Madhya Pradesh and Rajasthan
Project
components
• Equipment and Premix on sliding subsidy
• Technical support & capacity building
• Quality Assurance & Control protocols
• Advocacy for supportive legislation
• Develop communication strategy and its Roll out
Stakeholder alliance and consultation
• Process monitoring and reporting
• Using data for course correction
Production & Distribution
Legislation & Quality
Control
Social Marketing &
Communication
Monitoring & Evaluation
Project Management• Project implementation
• Dissemination of results to scale up
Input
1. Equipment
2. Premix
3. Financial
support
4. Technical
support
5. Policy
advocacy
1. Partnership
2. Production,
3. Advocacy
4. Marketing
5. M&E
6. Training
7. QAQC
1. Availability
2. Acceptability
3. Accessibility
4. Affordability
5. Awareness &
consumption
of fortified
foods
1. Improved
anaemia &
vitamin A
status
2. Increased
wheat flour
fortification
by industry
Reduction in
anaemia &
vitamin A status
in the population
and the
attendant health
benefits
Outcomes Process Output Impact
Project Logical Framework
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Policy Advocacy Leading to Regulatory
Support for Fortification
Current regulation and supportive environment:
The Food Safety and Standards Authority of India (FSSAI) permits
fortification of foods
National Nutrition Mission highlights the need to focus on
micronutrient fortification.
India’s 10th, 11th and 12th Five Year Plans recommend food fortification
as important strategy to tackle micronutrient malnutrition
Ministry of Food Processing Industry, GOI, provides financial
assistance to the Food Industry for capital equipment and its
installation for undertaking fortification, and value addition
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How Micronutrients Impact Our Quality of Life
Improved Vitamin and
Mineral Status
Improves Immunity
Decreases Anemia
Improves Cognitive Skills & education
Better School Achievement
Increased Productivity & incomes
Decreased Mortality
Improved Quality of Life
As policy makers, public health and nutrition professionals,
economists and business representatives, we cannot stand by while
micronutrient deficiencies cause enormous loss of life and impose
chronic disabilities of mind and body on future generations in India
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Foods and Channels Used for Fortification
ICDS Midday Meal
programme PDS
Fortified Foods
through Open market
Salt
Milk
Wheat flour
Oil
Mass Fortification of
Foods Through
Commercial Channels
Fortification of Foods Provided
Under
Public Funded Programs
Integrated Fortification Project
Fortified wheat
flour/fortified rice/
fortified soyadal
analogue, iodized
salt and fortified oil
Fortified wheat
flour in place of/
conjunction with
grains, iodized
salt & fortified oil
Children 3-6 yrs:
Fortified wheat
flour/fortified rice/
fortified soyadal
analogue, iodized
salt and fortified oil
Rice
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Achievements: Projects have good will, support and recognition from
Industry, State Govt. Counterparts and the Polity
Vehicle
Avg.
Production
(MT)/ Year
Reach
(people in
millions)
Samples
tested
(monthly)
External
pass rate
Fortified Wheat Flour in
Rajasthan (direct support)90,000 1.5 33 85%
Fortified Wheat Flour in
Rajasthan (Leverage)840,000 9.8
Not
available
Not
available
Fortified Oil in Rajasthan 246,000 38.5 12 100%
Fortified Milk in Rajasthan 528,000 7.35 66 100%
Soyadal analogue for lentil
fortification in Rajasthan76.8 1.1 12 100%
Fortified Wheat Flour in MP
(direct support)222,000 3.5 24 87%
Fortified Wheat Flour in MP
(Leverage in other states)816,000 12.6
Not
available
Not
available
Fortified Oil in MP (direct
support)240,000 35 6 100%
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Our Challenges
Nutrition and Food Fortification are not sufficiently prioritized in India
and resources for nutrition improvement are not optimised
Lack of effective overall consensus and coordination between
sectors at national level on how to move forward for improving
nutrition and health
Insufficient motivation and capacities at national and decentralized
level to design, implement and monitor interventions
Mainstreaming fortified wheat flour in the Public funded programs
like Public Distribution System, ICDS and MDM: Conversion of
grains to fortified wheat has huge financial implications and limited
shelf-life of fortified wheat flour is an impediment. Requires a political
decision
Food Processors desire fortification to be made mandatory to give
them a level playing field
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Lessons Learnt and Way Forward…..
1. Staple Food Fortification is do-able and very cost-effective
2. Food fortification does not lead to organoleptic changes and hence
widely acceptable
3. Processing is simple and does not require expensive equipment.
Food industry can thus do it at very low investment
4. Industry is responsible and ensures appropriate fortification and
takes pride in contributing to nutritional improvement
Strengthen regulatory monitoring to ensure the quality and
safety of fortified foods
Make it mandatory to fortify oil and milk with vitamin A and D
Promote a national logo to indicate that the food is fortified…. It
could be a yellow star and promoted as we promote red / green
dots for vegetarian and non-vegetarian foods
Create awareness about the goodness of fortified foods.
Nutrition is a cross-cutting issue and coordinated efforts of many
sectors are required ….. We need to join hands and not work at
cross-purpose
WAY FORWARD
Staple Food Fortification is an evidence based strategy and
a practical solution which needs to be scaled up in India ….
What we need is a strong political will and policy support